Contingency management (CM) is a general behavioural intervention technique used in the treatment of drug dependence to systematically arrange consequences and it is designed to weaken drug use and strengthen abstinence.
The main elements of CM interventions are behavioural reinforcers and monitoring, which aim to promote social reintegration by sustaining compliance, abstinence and/or attendance at work.
We performed a systematic review of studies on the effectiveness of CM alongside pharmacological treatment of dependence.
We included 38 studies on opioid users (n = 20), cocaine users in methadone therapy (n = 14), cocaine users (n = 3) and methamphetamine users (n = 1). We found that CM was useful for reducing drug use among cocaine users and opioid users in substitution treatment for reducing and abstaining from cocaine use. In opioid detoxification, CM increased retention in treatment and improved abstinence. In terms of the cost-effectiveness of CM, the evidence is not strong enough to recommend its systematic implementation.
We included three studies on the economic analysis with evidence for cost-effectiveness analysis: one review (based upon nine published studies) and two additional studies. The review confirms that evidence for cost-effectiveness has limited generalisability beyond original research.
Our limited analysis shows that CM is a feasible and promising adjunct to treatment interventions for drug users.